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Diabetes

I suffer from the disease Diabetes Mellitus and I am a type I (one) case, an insulin dependant diabetic. I was diagnosed at the age of 14 through a combination of symptons; extreme weight loss (3 stone in 2 months), massive fluid intake (around 24 litres a day at the end) and extreme stomach pain/cramps/vomiting.

I have included this section to educate people into what diabetes is and provide links to find out more about the disease. If you do have questions let me know but I’m not promising I’ll be able to tell you anything useful!

I’ve also got a page that has some translations of medical phrases that might be useful to you when on holiday or business.

Diabetes Mellitus

Diabetes Mellitus is a disease caused by defective carbohydrate metabolism and characterized by abnormally large amounts of sugar in the blood and urine. Diabetes mellitus affects about 16 million people in the United States, of whom about half remain undiagnosed. Diabetes mellitus can eventually damage the eyes, kidneys, heart, and limbs, and can endanger pregnancy. Proper treatment, however, can minimize these complications.

Diabetes mellitus is usually classified into two types. Type I, or insulin-dependent diabetes mellitus (IDDM), formerly called juvenile-onset diabetes, which occurs in children and young adults, has been implicated as one of the auto immune diseases. Rapid in onset and progress, it accounts for about 10 to 15 percent of all cases. Type II, or non-insulin-dependent diabetes mellitus (NIDDM), formerly called adult-onset diabetes, is usually found in persons over 40 years old and progresses slowly. Often it is not accompanied by clinical illness and is detected instead by elevated blood or urine glucose levels.

Cause and Course

Diabetes is considered a group of disorders with multiple causes, rather than a single disorder. The human pancreas secretes a hormone called insulin that facilitates the entry of the sugar glucose into all tissues of the body, providing energy for bodily activities. In a person with diabetes, however, the entry of glucose is impaired, a result either of a deficiency in the amount of insulin produced or of altered receptor cells (see Disease). Consequently, sugar builds up in the blood and is excreted in the urine. In the Type I diabetic, the problem is almost always a severe or total reduction in insulin production. In the Type II diabetic, the pancreas often makes a considerable quantity of insulin, but the hormone is unable to promote the entry of glucose into tissues. In some persons this resistance is due to prolonged obesity: A high level of blood sugar inactivates the tissue components, which, in turn, act as a target for insulin. If untreated, Type I diabetes can be quickly fatal. It is accompanied by extreme thirst, weight loss, and fatigue. Because the body lacks sufficient energy from tissue glucose, it begins to break down stored fat. This produces increasing amounts of compounds called ketone bodies in the blood, making the blood acidic and interfering with respiration. Death from diabetic coma was the usual outcome of the disease before the discovery of insulin therapy. In both forms of diabetes, moderately elevated blood-sugar levels for many years can eventually cause kidney disease; impairment of sight due to rupture of blood vessels in the eyes; reduction of blood flow to the limbs, which can cause numbness and sometimes necessitates amputation; and alterations in nervous sensation. Diabetics also have an increased risk of heart attack and stroke. Uncontrolled diabetes in a pregnant woman is associated with increases in stillbirths and birth defects. The life span of an inadequately treated diabetic is shortened by about one-third.

Detection of Type II diabetes in the absence of symptoms starts with measurement of the glucose level in urine. If a high level is detected, the amount of blood sugar is measured after an overnight fast. A high value indicates diabetes, and those with a normal level then undergo an oral glucose tolerance test in which the amount of glucose in the blood is measured after ingestion of a large amount of the sugar.

In 1996 researchers discovered the first genetic link to Type II diabetes. The exact role of the gene, which controls storage of sugar in muscle tissue, has not yet been established. The gene has been found in one-third of people with Type II diabetes and is believed to indicate possible susceptibility to adult-onset diabetes.

Treatment

With adequate treatment most diabetics maintain blood-sugar levels within a normal or nearly normal range. This enables them to live normal lives and prevents some long-term consequences of the disease. For the Type I or Type II diabetic with little or no insulin production, therapy involves insulin injections and changes in diet. The diet requires distributing meals and snacks throughout the day so that the insulin supply is not overwhelmed and eating food that contains polysaccharides rather than simple sugars. (Polysaccharides must first be broken down in the stomach, therefore producing a much slower rise in blood sugar.) For Type II diabetics, most of whom are at least moderately overweight, the basics of therapy are diet control, weight reduction, and exercise. Weight reduction appears to partially reverse the condition of insulin resistance in the tissues. If a patient’s blood-sugar level is still high, the physician may add insulin injections. An oral sugar-lowering agent may be prescribed for persons who do not require insulin addition to control their diabetes, as well as for those who have trouble injecting themselves or whose diabetes is not controlled by insulin addition.

Some diabetes patients are now equipped with insulin pumps, carried on the body, that deliver insulin at preset times and rates. Such pumps improve control over blood-sugar levels, although acute but nonfatal complications such as ketoacidosis and infection of the infusion site are sometimes observed.

In 1983 a group of 1400 insulin-dependent people ages 13 to 39 participated in the Diabetes Control and Complications Trial (DCCT), the largest study of diabetes treatment ever undertaken. The DCCT studied the potential for reducing diabetes-related complications (such as nerve or kidney disease or eye disorders) by having patients closely monitor their blood glucose level several times a day, making sure it was as close to normal as possible. Researchers revealed the study findings in 1993, having found a 50 to 75 percent reduction in complications related to diabetes in people who aggressively monitored and controlled their glucose levels. Although the study was performed on people with Type I diabetes, researchers believe that the changes in treatment would also have benefits for people with Type II diabetes.

In late 1995, the Food and Drug Administration (FDA) approved the use in the United States of a new drug to treat Type II diabetes. The drug, called acarbose, controls blood sugar by slowing the digestion of carbohydrates.